Ballismus as a sign of transitional ischemic attack

A 70-year-old woman presented to our emergency center with a complaint of jerking and twisting movements in her left upper limb and left ankle with deviation of her mouth toward the left. The movements had lasted two minutes and the deviation resolved spontaneously after 30 minutes. She had a history of similar movements five days earlier. During her stay in the emergency center, she experienced the same movements three times. A CT scan without contrast showed a small lesion in the left putamen. Four vessel color Doppler sonography showed a small atheroma plaque in the proximal part of the left internal carotid artery with stenosis less than ten percent. The repeated CT scans revealed progression of the hypodense lesion and the patient developed hemiparesis. In this case, ballismus movements were a cardinal sign for a future stroke and her problem can be considered a recurrent transient ischemic attack or a stroke in evolution.